壁内で内反性増殖し胃内へと穿破し短期間に著明な形態変化を来した食道癌の1例

A Case of Esophageal Cancer with Inverted Growth within the Esophageal and Gastric Wall, Perforating the Lumen of Stomach, with Marked Morphological Changes over a Short Time

要旨●患者は50歳代，女性．検診時の上部消化管内視鏡検査（EGD）で食道と胃に潰瘍性病変を指摘された．2か月後のEGDで下部食道に小潰瘍を伴う粘膜下腫瘍（SMT）様隆起と胃噴門直下前壁側に乳頭状の隆起性病変を認め検診時の内視鏡所見と比較して大きな形態変化を呈していた．生検では食道・胃病変ともに扁平上皮癌であり，胸部下部食道切除＋胃全摘が施行された．切除標本では高分化扁平上皮癌が乳頭状に発育しており，下部食道に認めた陥凹部より内反性に増殖し胃壁浸潤を来していた．食道癌が内反性に増殖して胃壁へ浸潤し，胃内腔へ穿破したことで，約2か月間で劇的な形態変化を来した1例を経験したので報告する．

　The patient was a woman in her 50s. She underwent upper gastrointestinal endoscopy（EGD）during a medical checkup, which revealed ulcerative lesions in the esophagus and stomach. Two months later, a second EGD revealed a submucosal tumor-like protuberance with small ulcers in the lower esophagus and a papillary protuberance on the anterior wall just below the gastric cardia. These findings showed significant morphological changes compared to the earlier endoscopy performed at the time of the checkup. A biopsy revealed squamous cell carcinoma in both the esophagus and stomach. Thus, the patient underwent thoracic lower esophagectomy and total gastrectomy. Based on the resected specimen, the carcinoma was diagnosed as well-differentiated squamous cell carcinoma that had grown in an inverted manner from the small hole observed in the lower esophagus and had invaded the stomach wall. In summary, we report a case of esophageal cancer that had grown in an inverted manner, invaded the stomach wall, and ruptured into the gastric lumen, causing a dramatic morphological change over approximately two months.